THE SURGEONS

Life and Death in a Top Heart Center

The versatile Morris (The Tycoons: How Andrew Carnegie, John D. Rockefeller, Jay Gould, and J.P. Morgan Invented the American Supereconomy, 2005, etc.) brings his customary research and observational skills to probe the heart industry.

For it is an industry: fueled by discoveries, purveyed by artists and craftsmen supplied by medical schools, in demand by customers who shun the alternative. Heart disease is the number-one killer worldwide. In good hands, as the author graphically describes, even some of the worst cases—heart patients with multiple chronic ills and earlier surgery—survive to thrive. Morris spent a year at New York’s Columbia-Presbyterian Hospital watching coronary bypass surgeries, transplants, valve replacements and congenital-defect corrections, performed by some of the world’s best—the surgeons, anesthesiologists and nurses. No question, the doctors are dedicated (and well paid). Surprisingly, those at Columbia form a mutual-admiration society—no primal egos here. The author reiterates what the data show: If you’re a patient, you would be wise to go to a top-tier hospital whose ORs are busy 24/7 rather than one performing a few procedures a year. While Columbia treats some indigent patients, Morris leaves to the end the issue of haves and have-nots, seeing only incremental changes to expand insurance coverage and lamenting the emphasis on high-cost, high-tech therapies rather than prevention. The tech focus is largely driven by R and D, he observes. Science is moving toward less invasive procedures: stents to open blocked arteries and robotic instruments working through small incisions, rather than the breaking-the-chest-bone-and-entering styles of the past. Thus interventional cardiology, the medical specialty which allows placement of stents and angioplasties, is the hot new field, while heart surgery declines. The future may see a merger of the two specialties.

The drama of surgery conveyed by an eyewitness with the smarts of an American business watcher will appeal to the general public but be of particular pertinence to patients and policymakers.